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FOR OFFICE USE: '7 vl' — �¢ Permit No. ""�/� " -� FOR FOR SANITATION PERMIT -A----------------- ,C-Ic x_-------- -'�-_ (Complete in Duplicate) -Date Issued __ -•�� ` ---- ► --------- ---p----------- _ This Permit Expires 1 Year From Date Issued A lication is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. � �` This application is made in complian ie with County Ordinance No. S49. �U✓� \_� ;7- JOB ADDRESS AND LOCATION•3-�'/ - r-----I ----- -`------------ -` � --------•- - Phone-.�-------•------••-------------• ------------------------------------- ------- Owner's Name1.� rC `k� !./1G.'e� -•--•--- -------------------------------------------------------------------------- Address. � -'s .-------------------7 /// Phone_-.---------••---------------•-- Contractor's Name-------- ''-----•-------- -- l Other ❑ Installation will serve: Residence, Apartment House [IMote Commercial ❑ Trailer Court.❑; ❑ er R � Number of living units; _�_"= 'Nurriber of bedrooms - �__ Number of baths---t_=_-Lot size--- -------- Communit stem ❑ -Private YL Depth to Water Table eft � Water Supply: Public system r-1Comm system Adobe Lo Hardpan ❑ Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ F New Construction: Yes No ❑ . FHA/VA: Yes ❑ No ❑ Previous Application Made: (If yes,'date-.------- 1 No ❑ TYPE OF INSTAL LATION AND SPECIFICATIONS: C (No septie'tank or cesspool permitted if public sever is available within 200 feet.) Septic Tank: Distance from nearest well --•Distance from .foundation- .! ---•--.Matenai-_.- --- .. ® -�No. of compartments Size Liquid depth----&------------ Capacity �� Disposal Field: Distance from nearest well--- -..Distance from foundation----1�-�•---Distance to nearest lot lire----------------- ,1 Number of lines-------------�._."---------------Length of each lines!-/_3 l I9_,4'8�slidth of trench-----_--- -.-"--------------- ® Type of filter material-�Ojir-k-_-----Depth of filter_material---le----------Total length------ -------------Distance to nearest lot line----------------- �-._--•-•-----• k Seepage Pit: Distance to nearest well------------------_--Distance from foundation-__-.. l ❑ Number of pits--_.--- -Lining material___- Size: Diameter"_ Depth------ ---------••-------- Cesspool: Distance from nearest well ,_---_Distance from Joundation-------------------Lining material--_"----."_-.---- _ .-_---.-----.---. Liquid Capacity gals. Size: Diameter-------------------------------------- #❑ Distance from nearest well-----"_,i-----------=------'--- = .-Distance from nearest building------------------------------"---.------ Privy: , ----------. ❑ Distance to nearest lot line--_ _.._------------- --- --- - ----•,... Remodeling and/or repairing.(describe):-------- ------ -----------'-----------------------------------•--••----------- -----••--------•---- ----- -------- --••-----•--------------- P ----------------------------------------------------------_-------•-------•---------- •---- -----------------•----------------------------------- ---------•---------- •-------- 1 hereby certify that I have prepared this application and that the work will'be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed) - --------�` = - --------- ----------------------------- -------- ---.(Owner and/or Contractor) q Signed ----- - --- ---------- - ,. = -- -- ------------------------(Title)--------- --------------------�--- ------- - -- -------.------ By=-------------------- ----------------------- ------------- - (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----V------ - � ---------------------------------------- ---------------------- DATE-----12-P..Z(+ (r ""------------- - ------------------ --- ------ DATE----------- •--- ------ ----------------- REVIEWEDBY------------------------------------- - ---------_---------------------------------------------- -----------. DATE.-.---------- ----------------------------------------------- BUILDING -------------- BUILDINGPERMIT.ISSUED-------------------------------•----------------------------—------------------- --•---- Alterations and/or recommendations:- -.. -s - _ ------ ... �- � _ u . 1 ------" - --- � � / ;-- te i' ----- y Date-------- - ----•------ -- =-------- --- --- ----------- FINAL INSPECTION BY:"----- -- ---------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California EB-9 REVISED 8-59 F.P.00.ZM 5-60